Making the most out of your next visit to your Specialist.
I’ve recently retired after 30 years of medical practice, having seen thousands of patients in that time. Over the last 18 months I’ve spent a lot of time on the other side of the desk in the patient’s chair. Most of that has not been related to my Parkinson’s so it’s been eye opening for me to be in that position. I’ve often felt like I’ve been in a “limbo state”, with colleagues treating me a little different to a patient who is also a doctor. That has not always been a good thing!
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The upside of my experience, which included about of COVID, mild depression, five operations and of course Parkinson’s, is that it has given me a lot of think about regarding doctor-patient interactions.
I’d like to share some suggestions about how to make the most of your next specialist visit; these pertain mainly to Parkinson’s, but they could also apply to other specialties. Appointments with specialists such as neurologists tend to be infrequent, typically every 6 months; sometimes more, sometimes less. I observed some people being quite nervous about their visits, speaking quickly and trying to make the most of every minute, only to forget a crucial question they wanted to ask. It’s important to take some time to prepare. I’d suggest the following;
In the weeks before
Make sure you have an up to date referral; this will usually mean a visit to your GP. The referral is an integral part of the Australian Medicare system, which should help enable better communication between GP and specialist. Without a referral you will not be able to claim a Medicare rebate.
If the specialist has ordered tests (e.g. .scans, blood tests), make sure there is plenty of time for the results to become available- I’d recommend about a week. Never assume that the lab or radiology firms will get the results to the specialist. In my private practice I’d always look up the results the night before to ensure I was ready for the consultation and also to avoid wasting precious time during the consultation.
If you have paperwork that needs completion, e.g. insurance forms, driver’s license renewals, let the specialist know this before the consultation. Often they will need to ask you questions in order to complete these forms. Don’t assume they know what your occupation is, and what it involves- insurance forms often ask for this. I now understand how important these forms can be; it’s very stressful if your driver’s license is due and you don’t have an appointment. It’s also frustrating for the doctor to be given a huge form that needs to be done urgently during the last minutes of a consultation
On the day
Make sure you leave plenty of time to get there. Parking is at a premium around most major medical centres, so allow extra time especially in the middle of the day. If you are running late, call the office or clinic; that way the doctor can readjust their list. Sometimes it may be better to reschedule than to see a doctor who is rushing.
If your appointment is late morning or late afternoon, it usually means you are one of the last patients to be seen in that doctor’s session of work. Most doctors tend to “get behind” the clock as the session progresses, so don’t be surprised if your allocated time comes up and you are still waiting to be called. Make sure you communicate with the secretary; good secretaries will call you to advise on “how things are going, and if the doctor is running to time.” Emergencies happen, and sometimes an appointment becomes more complicated than expected, so the doctor gets behind time. Rather than getting upset, consider the extra time and attention you would want if something came up that needs extra time. If you are last on the list, you may get bonus extra time; I would sometimes schedule a complex follow up last, so there was no stress about running late and making the next patient wait.
Wear clothes that you can remove and put back on easily to allow for examination. Things get missed if doctors don’t examine you thoroughly, and usually this requires proper exposure. Bring someone with you; spouse, carer, friend. Another set of eyes and ears is invaluable.
Make sure you bring an up to date list of medications with doses, and for Parkinson’s medications the times when you take them. The specialist will usually be happy to write scripts for Parkinson’s medication, but may not be comfortable with medications for other conditions they are less familiar with.
If you are taking L-dopa, it will be useful for you to think about a few aspects;
1. Do you feel it is making a difference to symptoms, and think of examples e.g. effect on handwriting.
2. Can you feel the effect coming on, or wearing off?
3. When do you take medications in relation to meals?
4. Have you noticed any difference if you have been late on a dose or missed a dose?
5. Have you had side effects; e.g. nausea, light headedness?
Don’t forget non-motor symptoms; e.g. depression, lack of motivation, changes in mood, intolerance of extreme temperatures, sleep disturbances, bladder and bowel problems.
It may also be useful to think about how your overall symptom control compares to 3, 6 and 12 months ago, and before and after any medication changes. Think about any change in specific activities you regularly do over time such as how easily a regular walk might be, can you put your pants on whilst standing up, can you still do up buttons unassisted?
Importantly, bring a written list of questions, with the most important ones at the top of the list.
Don’t be afraid to ask questions. If you don’t understand something, be sure to ask for further explanation.
At the end of the consultation be sure you understand if there are to be any changes in medications or tests. Be sure to ask about side effects of new medications.
Make sure you have a means of making contact before the next appointment. Most doctors should be prepared to be contacted through work e-mails. Don’t expect to be given a private e-mail address or mobile number.
Ask for a copy of the letter from your visit to be sent to you; this will help remind you of what was covered and is useful to keep in your records. Also ask for any results to be copied to you as well.
I hope that these suggestions make your next visit the best possible experience.
David Blacker AM, MB BS, FRACP
Medical Director, Perron Institute
Board member, Parkinson’s WA